When does the cardiovascular disease appear in patients with chronic kidney disease?

Pediatr Cardiol 2010 Aug 17;31(6):821-8. Epub 2010 Apr 17.

Department of Pediatric Nephrology, Faculty of Medicine, Ege University, Izmir, Turkey.

Cardiovascular disease is a leading cause of long-term morbidity and mortality among children with chronic kidney disease (CKD). At which stage of CKD these appear in children is unknown. This study aimed to determine the prevalence of cardiovascular disease in pediatric CKD patients and to explore the relationship of these changes and treatment methods. The study enrolled pediatric patients with stages 1-5 CKD including 20 patients receiving predialysis (PreD), 8 receiving peritoneal dialysis, and 14 receiving hemodialysis. Aortic stiffness, defined as decreased aortic strain (S) and increased pressure strain normalized by diastolic pressure (Ep*), was described. Sonography of the common carotid artery and left ventricle was performed. The mean age of the children was 13.3 + or - 5.3 years. The patients had lower S values (0.35 + or - 0.23) than the control subjects (0.44 + or - 0.2) (P < 0.05) but higher Ep* (2.46 + or - 1.31 vs. 1.32 + or - 0.09; P < 0.05). Aortic stiffness was found in 13 patients. The PreD group had lower As levels than the dialysis group but higher levels than the control group. The patients (n = 32) had greater carotid intima-media thickness than the control subjects (0.58 + or - 0.14 vs. 0.35 + or - 0.12; P < 0.05). The intima-media thickness was greatest in the PreD group (P < 0.05). The patients had a higher left ventricular mass index (LVMI; 42.4 + or - 15.6) than the control subjects (28.8 + or - 8.47) (P < 0.05) and a larger left ventricle end diastolic diameter (LVEDD; 3.44 + or - 0.76 vs. 2.59 + or - 0.34; P < 0.05). Left ventricular hypertrophy was found in 32 patients. Both LVMI and LVEDD were higher in the groups receiving hemodialysis and lower in the PreD group. Increased carotid-intima media thickness and left ventricle hypertrophy appeared without hypertension in the PreD group. The indications and timing of dialysis should be reevaluated for children with CKD. In the dialysis groups, fewer cardiovascular changes were found with peritoneal dialysis than with hemodialysis. Therefore, peritoneal dialysis should be preferable to hemodialysis for children with CKD.

Download full-text PDF

Source
http://dx.doi.org/10.1007/s00246-010-9710-0DOI Listing
August 2010
22 Reads

Publication Analysis

Top Keywords

pred group
16
peritoneal dialysis
12
control subjects
12
left ventricle
12
cardiovascular disease
12
patients
9
intima-media thickness
8
children ckd
8
receiving hemodialysis
8
aortic stiffness
8
left ventricular
8
chronic kidney
8
ckd
6
group
6
005
6
dialysis
6
pred
5
left
5
children
5
dialysis group
4

References

(Supplied by CrossRef)

MA Alpert et al.
Contrib Nephrol 1986

AR Bakiler et al.
Pediat Nephrol 2007

J Blacher et al.
Hypertension 1998

BM Chavers et al.
Adv Chronic Kidney Dis 2004

A Covic et al.
Am J Kidney Dis 2005

A Covic et al.
Nephrol Dial Transplant 2006

RB Devereux et al.
Circulation 1977

G Simone De et al.
J Am Coll Cardiol 1992

A Fagot-Campagna et al.
J Pediatr Endocrinol Metab 2000

RN Foley et al.
Kidney Int 1995

Similar Publications